Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | DC6933 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 781475 | TX |
NPI | 1649338815 |
---|---|
Provider Name | Daniel Bradley Burdin |
First Address | San Antonio, TX 78229-2382 |
Second Address | San Antonio, TX 78229-2383 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 24/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
644411ZGVZ | MEDICARE (01) | TX |
8A7046 | BLUE CROSS BLUE SHIELD (01) | TX |
U59688 | (02) | TX |